The Provincial Governor/City Mayor
Provincial/City Mining Regulatory Board
Province/City of ___________________
Sir :
In accordance with the provisions of the Philippine Mining Act of 1995 and its
revised Implementing Rules and Regulations, the undersigned __________________ for
and in behalf of __________________________, hereby applies for a Commercial Sand
and Gravel Permit to remove and dispose _____________ cubic meters of materials
authorized thereunder from the tract of land bounded as follows:
On the North ____________________________________
On the East

____________________________________

On the South ____________________________________
On the West

____________________________________

with an approximate area of __________________________ hectares.
The area applied for is public and/or private land, lake, river, stream, creek
other public waters (underline applicable term), located in the Sitio
_________________, Barangay of _______________________, Municipality
____________________, Province of ___________________________, Island
_________________, Philippines.

or
of
of
of

1.

The application fee of _________________________ has been paid under
Official Receipt No. ____________ dated __________________, Philippines.

2.

The applicant binds himself or itself to pay the amount of _________________
(P______________) covering the total fee for the materials applied for, and to file
a __________________________ bond (surety, cash or personal) in the amount
of ________________( P ____________);

3.

This application is filed for the exclusive use and benefit of the applicant, and not
either directly or indirectly for the benefit of any other persons, corporation or
partnership, and for the sole purpose of removing and disposing of the said
materials;

1

MGB Form No. 08-3A

4.

The applicant agrees that the statements made in the application or made later in
support thereof shall be considered as conditions and essential parts of the permit
that may be granted by virtue thereof, and any falsehood in these statements on
omission of facts which may later change or affect substantially the facts set forth
in said statements shall be sufficient cause for the cancellation of the permit
granted.

The foregoing statements are hereby certified to be true to the best of the
applications knowledge and belief.
I, __________________________, the person executing this affidavit for this
application, being first duly sworn, depose and say: that I have read or have caused the
foregoing application read to me; that I thoroughly understand the same; that each and
every statement in said application is true and correct.

___________________________
Applicant
TIN _______________________

ACKNOWLEDGEMENT
Republic of the Philippines _____ )
Province of ________________ ) S. S.
City/Municipality of _________ )
SUBSCRIBED AND SWORN to before me at the place aforesaid, on this
__________ day of ____________________, 19_____. The affiant exhibited to me
his/her Community Tax Certificate No. ____________ issued at ___________ on the
___________ day of _______________, 19____.

This application shall be accomplished in quintuplicate, two copies to be retained
by the applicant, the original and one copy to be forwarded to the Provincial/City
Mining Regulatory Board, and the remaining copy for the files of the MGB
Regional Office.